Monday, July 18, 2011

Mommy Makeover Abdominoplasty with Pelvic Sling for Urinary Incontinence

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Urinary incontinence (leaking of urine) can be problematic and embarrassing for women past their childbearing years. Pregnancy and/or the aging process weakens or damages nerves, muscles and/or their supporting structures in the pelvic area. This results in incontinence (inability to hold back urination). There are different types such as stress incontinence, urgency incontinence etc. After trials of non-surgical treatments such as injection of bulking agents around the urethra (tube extending down from the bladder that urine flows through) have failed sling or bladder neck suspension surgical procedures may be needed to treat stress incontinence.

Sling Procedures for Urinary Incontinence

sling procedure for urinary incontinence
In the sling procedures a piece of human or animal tissue or a synthetic tape is passed around the urethra and then over the pubic bone. Alternatively the sling can be passed through holes in the bone know as obturator foramen and passed under the urethra. The sling lifts the urethra and changes the angle between it and the bladder so that urine dose not come done the urethra or leak until the bladder contracts in a controlled manner in the bathroom.

Bladder Suspension Procedures for Urinary Incontinence

Suspension procedures involve placing stitches (sutures) in vaginal tissue near the bladder neck (where the urethra and bladder meet) and then passing the stitches to a ligament near the pubic bone (Burch procedure) or in the cartilage of the pubic bone itself (Marshall-Marchetti-Krantz procedure). These sutures reinforce the urethra and bladder neck so that they don't sag.

Urethra Before (Left) and After (Right) a Sling Procedure

Because of social stigma, an estimated 50 to 70% of women with urinary incontinence do not seek medical evaluation and treatment. Only 5% Of women with urinary incontinence in the general population and 2% in nursing homes receive appropriate medical evaluation and treatment. Women with urinary incontinence often endure this condition for 6 to 9 years before seeking medical treatment.

Both types of procedures can be performed via an abdominal incision that can be incorporated into an abdominoplasty procedure.

Some surgeons prefer to do these separately for fear of infection because the bladder procedure involves operating inside the abdomen of abdominal organs. Although that is theoretically correct I have not found that to be a problem. Extra care needs to be taken in order to avoid cross contamination. I have also performed abdominoplasty in conjunction with a tubal ligation and vaginal tightening performed by an OB/GYN and have not had a problem with that procedure either.

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